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School Policies for Children with Diabetes in Eastern Canada

In Canada, there are no federal policies that govern the care of children with diabetes in schools. Education is under the jurisdiction of each province and it is up to the province or individual school boards to put in place a policy or other form of protection for children with diabetes in their school systems. Below are provisions made in both Ontario and Quebec.

Ontario

Policy for provision of Health services in a School Setting

Policy No. 81 (July 1984)

The Ontario Government has decided that the responsibility for ensuring the provision of such health support services will be shared among the Ministries of Education, Health, and Community and Social Services. Responsibility for the direct provision of these services at the local level will be shared by the school
boards, the Home Care Program of the Ministry of Health, and agencies operating under the Ministry of Community and Social Services. The Home Care Program of the Ministry of Health, at the request of a school board, will be responsible for assessing pupil needs, and for providing such services as injection of medication.

Specific Ontario School Board Policies

Blue Water School District

1. The parent shall provide to the principal/designate, written evidence, as provided by the practicing physician,
that the student has diabetes. Such evidence shall set out:

i. The name of the child

ii. The emergency procedures to be taken

iii. The frequency/times to administer medication

iv. The anticipated reaction and may include other pertinent information as provided by the
physician ( e.g. symptoms/side effects)

2. When a student with diabetes registers at school, the principal shall establish develop and maintain an
appropriate response plan using the materials and guidelines contained in the “ Provisions for Medical and/or Physical
Assistance Within the Schools” Manual.
a)The plan shall include the following:
(1) a process which will encourage parents/guardians of a student with diabetes to identify the
student to school staff,
(2) a process to inform all students, staff, and parents/guardians of their responsibilities in
dealing with children who are living with diabetes in the school;
(3) a written Diabetes Emergency Treatment Protocol AF 6805 for each student identified as living with diabetes,
agreed to by
a)parents/guardians, a physician, diabetic nurse and the school staff; and
b) plans to address diabetes issues arising from transportation, field trips, and other school
activities.
c) the dissemination of specific information to staff members regarding individual students with
diabetes;
d) the publication of more general information about diabetes for the school council, students’
council and other school organizations as appropriate;
e)for each identified student living with diabetes, providing a clean, private location
appropriate to the student’s needs and sufficient time to test their blood;
f)providing for the safe disposal of lancets and needles;
g)in the details for Creating Safe and Healthy Schools for Students Living With Diabetes

3. When a request for the administration of oral medication is received from the parent or guardian of a
student, the principal will have the parent /guardian complete the appropriate signed “Request for Assistance”
form AF 6802. School staff will perform assistance as outlined in “ Provisions for Medical/and or Physical
Assistance” AP 6802.

4. If a student, as attested to by a regulated health professional, requires regular and ongoing assistance for
monitoring and supervision in respect to diabetic testing, the principal/designate should deploy Educational Assistant
time to provide the support. It is understood that any staff person involved in these procedures is acting in “loco
parentis” and not as a health professional. When the Student Care Plan has been developed, staff providing assistance will be trained in the procedures by qualified health professionals to ensure safety of staff and student.

5. The Board will identify initial and ongoing training required by Board personnel to provide appropriate physical assistance or health related procedures to students and communicate that need to the appropriate providers of training.

6. The principal will review the Bluewater District School Board General Guidelines for Creating Safe and Healthy Schools for Students Living With Diabetes with staff and the school council on an annual basis. (SEE Guidelines in “ Provisions for Medical and Physical Assistance Manual”)

7. Parents should provide schools with information on how to reach them on short notice to advise or assist staff regarding emergency arrangements including transportation to hospital. Current and accurate telephone numbers for parents/guardians and designated emergency contacts must be on file in the office. Note: In the event of an emergency, an ambulance will be called even if parents cannot be
reached.

8. Parents/guardians will authorize the release of relevant information to those who may be involved in the care of the student by completing and signing the Medical Problems (Critical) Request for Assistance and Medical Emergency Written Plan AF 6805. Please use the yellow binder, “Provisions for Medical and/or Physical Assistance” as a reference.

District School Board of Niagara

(a) Where a parent, guardian or pupil 18 years of age or older knows that a pupil has diabetes, the parent, guardian or pupil 18 years of age or older may request, in writing, that a Principal have on file a written action plan.
(b) Under these conditions, the Principal must make note of the Emergency Action Plan in the pupil’s Ontario Student Record Folder and make the plans for the emergency procedure known to appropriate teaching and support staff members so that appropriate assistance can be given to a pupil.
(c) Board staff are not required to administer any insulin injections or to use a glucagon

The following guidelines have been published by the Canadian Diabetes Association:
• School Board personnel are not responsible for giving insulin. Most insulin injections are administered outside school
hours before breakfast and supper meals and bedtime. Some students do require insulin injected before lunch, but this is the family’s and student’s responsibility, not that of the School Board personnel.
• School Board personnel are not required to do blood glucose tests but can agree to supervise a student capable of conducting a blood glucose test.

NOTE:
• Nothing in this Policy shall prevent a Principal or other staff member from administering emergency assistance to a pupil if the need arises.
• Action plans will be developed consistent with the roles and responsibilities outlined in Ministry Memorandum #81 (1984) and the Education Act.

District School Board Ontario North East

Health Support Services Policy (Policy Code 2.1.9)
Staff is to act in “loco parentis”. They must take some action supportive of student’s well-being. “High risk students”, such as those with Type 1 diabetes, should be brought to the attention of all staff members. Emergency treatment plans and photographs should be posted with the permission of the student’s parent/guardian. A copy of this plan shall be filed in the student OSR and left in the documentation file when the student is transferred to another school. The pupil is strongly encouraged to wear proper identification (ie. Medic alert bracelets) at all times and is responsible for providing or replacing in advance, supplies or equipment and training for any treatment required in a life-threatening situation. When supplies or equipment are entrusted to the Principal, they shall not be used until instructions have been received in writing from the parent/guardian or qualified medical authority. Authorized personnel shall, to the best of their ability, administer or assist the student to self-administer a treatment.

Halton District School Board

Administration of Prescribed and Emergency Medication–Elementary and Secondary
The administering of prescribed routine medication to student will only occur at the written request of the parent/guardian
and upon the prescription of the attending physician that the prescribed routine medication has been prescribed for used
during school hours. The principal has the primary responsibility for the administration of the medication but may designate the task to an employee. It is understood that the staff person is administering the medication under the principle of “in loco parentis” and not as a health professional. A signed authorization form, indicating parent request to administer prescribed routine medication by school personnel, as attached to this procedure is to be updated and submitted annually, and when changes occur, by the parent to the school principal prior to the administration of prescribed routine medication. The authorization Form 1, as attached to the guideline includes the
medication prescribed, special instructions, dosage, time of administering medication, method of administration, possible side effects. The signed authorization will be retained in the Medication Binder and indication of medication should be recorded on the student’s O.S.R. card. It is mandatory that a daily record be kept of the time, date, dosage, and type of prescribed medication given and initialled by the person who administered the medication. This information will be retained in the Medication binder in the medication storage area.

Halton Catholic School Board

Diabetes Management: A Protocol for Schools

This document is in word format and we were unable to find its exact location online. It was created to provide the school personnel in the Halton District School Board and the Halton Catholic School Board with information and guidelines regarding the requirements of care for students with diabetes.

Huron-Perth Catholic District School Board

Kawartha Pine Ridge District School Board

Parents are asked to tell the principal if their child does have a life-threatening illness so that an Emergency Response Plan can be developed.

Keewatin Patricia District School Board

Administration of Medication to Students and Medical Procedures to Students in the School
The parent/guardian of a high-risk pupil should be strongly encouraged to have the proper identification on the student at all times (i.e. Medic Alert Bracelet) and is responsible for providing, in advance, supplies or equipment for any treatment required in a life-threatening situation. Principals shall ensure that staff members (including education assistants, itinerant and occasional teachers, bus operators, lunch supervisors and their authorized personnel) are made aware of high-risk students in the school. In sharing such information, Principals must comply with the Municipal Freedom of Information and Protection of Privacy Act. A Life-Threatening Management and Prevention Plan (Form D1 and D2) must be completed and reviewed annually for each student who is considered to be at a high risk with respect to a life-threatening situation. The Life-Threatening Management and Prevention Plan will allow the Principal, school staff, parents/guardians, bus operators and drivers to have access to procedures in order to deal with an emergency situation. The plan is developed with appropriate input from parent(s), school staff, public health nurse, and communicated to appropriate staff, bus operators and occasional teachers. When a student, who has a plan, is attending an out-trip a copy of the plan shall accompany the teacher when a class excursion occurs. Any supplies and equipment, as identified in the plan, shall be taken by the teacher. When supplies or equipment are entrusted to the Principal, they shall not be used until instructions have been received in writing from the parent/guardian or qualified medical authority. The parent/guardian or qualified medical authority will train school personnel on the administration of medication to their child. School staff shall administer or assist the student to administer a treatment. Staff who administer medication by injection to students, having been trained by a medical professional, shall have full coverage under the Board Liability Policy. The training provided will be confirmed in writing by the medical professional (and the parent/guardian).

Lakehead District School Board

The local school board is responsible for the administration of medication to students attending school during regular school hours where it is absolutely necessary on an ongoing basis. Each school shall have a Medical Emergency Management Plan for any identified student. The principal shall establish emergency procedures for conditions such as diabetes. Staff who administer
medication to students, having been fully instructed by a health professional, shall have full coverage under the Board liability policy.

Northeastern Catholic District School Board

When the principal has been advised that a pupil will require medication on an on-going basis or in an emergency situation, the Principal shall obtain from the parent/guardian and the physician a completed and duly signed Authorization for Administration of Medication Form. Upon receipt of the completed form, the principal shall designate a person, other than a teacher, be responsible for supervising and administering the medication. The principal shall ensure that the physician’s instructions are clear and well understood by the designated person before medication is administered. The request and authorization by the parent/guardian and the physician shall specify the medication, the dosage, the frequency and the method of administration, the dates for which the authorization applies and any side effects, outlined by the physician. The original copy of all authorization and instructions shall be maintained in the pupil’s file, a copy retained by the parent, a copy by the principal and a copy by the appropriate medical personnel. When the Authorization for Provision of Health Support Services form has been duly completed and signed by the parent/guardian, the principal shall immediately contact the Community Care Access Program or the appropriate agency and give the pupil’s name, home address, the parent/guardian’s name, telephone number and other information pertaining to the program if requested. The principal in cooperation with the Community Care Access Coordinator and others as required, shall determine the needs of the pupil and participate in the construction of a written plan of care
which will adequately meet those needs.

Ottawa-Carlton School Board

Procedure PR632.SCO
January 4,2002
Ottawa-Carlton School Board’s “General Guidelines for Creating Safe and Healthy Schools for Students Living with Diabetes” is very extensive and specific. In-service training is to take place with all staff (including bus drivers), parents, and health officials. Provisions are made for hypo- and hyperglycemia. Staff are to be trained to provide injections, monitor food intake, and ensure that there is no sharing of food. A list of children with diabetes and their photos are to be posted in a location available to all staff. Parents are to be notified two days in advance of any change in activity. All group consumption of foods must first be discussed with parents to allow them to make any adjustments necessary.
To view Ottawa-Carlton School Board policy on diabetes go to: Procedure:PR.632.SCO

Simcoe Muskoka Catholic District School Board

Student Health Care Policy and Procedures
When you register your child in one of our schools, they encourage you to become familiar with their Student Health Care Policy and Procedures. It is critical that you provide the school with all relevant information relating to your child’s health care needs. In addition, there are forms that you will be asked to fill out and it is important that you return those forms to the school in a timely and accurate manner. They also urge parents to provide a Medic Alert bracelet for children who have life-threatening allergies or medical conditions.

Administration of Medicine: Uses standard procedures regarding the administration of medicine at school. Medication cannot be administered by school staff unless you have filled out and submitted a written consent form.

Trillium Lakelands District School Board

Community Care Access Centre should be initiated by the Principal for any student requiring medical procedures such as insulin injections. The principal shall ensure that a medical plan is created and an Authorization for School Board Health Support Services (Appendix B) is completed for students requiring special procedures.

Staff members including educational assistants, itinerant and occasional teachers, bus drivers, lunch supervisors and other authorized personnel are made aware of students with diabetes in the school by completing a Medical Care Plan (Appendix D) which will be reviewed annually for each student who has diabetes. A ‘Medically At Risk’ designation is affixed to the OSR, and noted where required on the student administration system. The parent/guardian of a pupil with diabetes should be strongly encouraged to have the proper identification on the student at all times (i.e. Medic Alert Bracelet) and if possible, directions on how to administer medications. The parent/guardian is also responsible for providing, in advance, supplies or equipment for any treatment required in a Life-Threatening situation.

8.2 Diabetes
Provide staff training sessions annually by a professional in the management of diabetes (in schools where there is a diabetic student). School personnel are not responsible for giving insulin injections. Establish a Medical Care Plan that is approved by a physician, parent/guardian and the school administrator, that clearly outlines procedures to be followed in the school setting for the monitoring of insulin levels and response to a perceived emergency diabetic reaction. Where there is an Individual Education Plan (IEP), The Medical Care Plan can be attached to the IEP. Provide referral to the CCAC for assessment/support for poorly controlled or newly diagnosed diabetes. Address blood glucose monitoring/insulin concerns. Provide a safe, hygienic and private space in the school for students to perform self blood-glucose monitoring and insulin injections throughout the day. Establish procedures (with assistance of the public health department and parents) for the safe disposal of sharps, lancets and testing strips. Designate a secure, accessible and appropriate place to store insulin, blood glucose testing supplies and emergency food supplies.

Upper Grand School District

Health Support Services
The Principal may consult with the Wellington-Dufferin-Guelph Health Unit and the Community Care Access Centre of Wellington Dufferin when establishing in-school procedures.

Principals shall ensure that:
a) staff members (including educational assistants, itinerant and occasional teachers, bus operators, lunch supervisors, and other authorized personnel), are made aware of high-risk students in the school. In sharing such information, Principals must comply with the Municipal Freedom of Information and Protection of Privacy Act;
b) a Life-Threatening Management and Prevention Plan form 509-4 must be completed and reviewed annually for each student who is considered to be at a high risk with respect to a Life-Threatening situation. The Life-Threatening Management and Prevention Plan(s) will allow the Principal, school staff, parents, bus operators and drivers to have access to procedures in order to deal with an emergency situation. The
plan will be developed with appropriate input from parent(s), school staff, public health nurse, Community Care Access Centre, and physician, and communicated to appropriate staff; including bus operators, itinerant and occasional teachers, educational assistants, and lunch supervisors and other authorized personnel, as soon as possible. The parent/guardian of a high risk pupil should be strongly encouraged to have the proper identification on the student at all times (i.e. Medic Alert Bracelet) and if possible, directions on how to administer medications. The parent/guardian is also responsible for providing, in advance, supplies or equipment for any treatment required in a Life-Threatening situation. When supplies or equipment are entrusted to the Principal, they shall not be used until instructions have been received in writing from the parent/guardian or qualified medical authority. School staff, to the best of their ability, shall administer or assist the student to administer a treatment.

Waterloo Catholic District School Board

Extensive guide to dealing with diabetes in schools. Highlights the importance of the school’s support after the initial diagnosis. Provides guidelines for emergency treatment and a good overview of diabetes care. This policy does state that teachers will not administer Glucagon.

DIABETIC INFORMATION
The foregoing statements of policy and procedure do not apply to prescription medication by injection on a regular basis (e.g. diabetic condition). Most diabetics, even very young students, are capable of managing their own sugar and insulin intake. The community health nurse should be advised of these students so that health education of the student and the classroom teacher may be reinforced. Where the student is unable to self-administer the medication, it is the responsibility of the parent or guardian to make suitable arrangements for its administration by qualified medical personnel or others, excluding school staff, deemed acceptable by the parent or guardian. In appropriate cases, the principal shall refer the parent/guardian to the Community Care Access Centre (CCAC).

Quebec

June 2011

Diabetes Protocol for Children with Type 1 diabetes in Quebec.
This new protocol outlines the roles and responsibilities of schools, boards, nurses, parents and students. It is quite comprehensive and allows for the training of glucagon to staff volunteers. The administration of insulin is still
primarily the responsibility of the parents but support can be given by staff.

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